Strengthening Shared Decision-Making for Older Adults with Kidney Failure Considering Kidney Transplant

考虑肾移植，加强肾功能衰竭老年人的共同决策

• 批准号: 10604364
• 负责人: Catherine R Butler
• 金额: $ 18.58万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-15 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10604364
• 关键词: Attention; Award; Bioethics; Caring; Clinical; Cohort Studies; Communication Tools; Complex; Consumption; Data; Decision Making; Development; Development Plans; Dialysis procedure; Elderly; Electronic Health Record; Environment; Epidemiology; Equity; Evaluation; Exposure to; Family member; Fostering; Foundations; Future; Goals; Hares; Health system; Healthcare Systems; Individual; International; Intervention; Interview; Kidney; Kidney Diseases; Kidney Failure; Kidney Transplantation; Life Expectancy; Mentors; Methodology; Methods; Operations Research; Patients; Physicians; Pilot Projects; Positioning Attribute; Predisposition; Process; Professional Organizations; Qualitative Methods; Qualitative Research; Randomized, Controlled Trials; Research; Research Design; Research Institute; Retrospective cohort study; Risk; Sampling; Scientist; Shapes; Structure; System; Testing; Time; Training; Transplantation; Transplantation Surgery; Treatment outcome; Uncertainty; Universities; Wait Time; Waiting Lists; Washington; Work; acceptability and feasibility; career development; clinical encounter; cohort; comorbidity; design; early experience; epidemiology study; experience; human old age (65+); improved; individual patient; innovation; insight; member; multidisciplinary; person centered; pilot test; psychosocial; racial minority; screening; shared decision making; tool; tool development; transplant centers

PROJECT SUMMARY / ABSTRACT The goals of this K23 application are to support shared decision-making for older adults considering kidney transplant evaluation and to facilitate Dr. Catherine Butler's transition to independence as a physician scientist whose research focuses on making the transplant evaluation process more person-centered and equitable. Kidney transplant can be a valuable treatment option for the growing number of older adults with kidney failure, but because of their limited life expectancy and high burden of comorbidity, most will not receive a kidney. Further, the transplant evaluation itself can be time-consuming, burdensome, and risky, especially for older adults who are particularly vulnerable to the complications of aggressive screening and treatments. Our preliminary work suggests that patients often have little understanding of what to expect from the transplant evaluation and limited opportunity to shape their involvement. A process of shared decision-making could help older adults to navigate the complex trade-offs and uncertainties involved in the kidney transplant evaluation. We propose an integrated research agenda intended to strengthen shared decision-making around referral for kidney transplant among older adults. First, we will conduct an interview-based qualitative study to elicit the experiences and perspectives of older adults with kidney failure related to the transplant evaluation process along with their family members and clinicians (Aim 1). Second, we will describe the duration and likelihood of completing discrete steps in the transplant process for a large national cohort of patients with kidney failure (Aim 2). Finally, informed by these first two aims, we will adapt and pilot-test a communication tool to support shared decision-making around referral for transplant among older adults with kidney failure (Aim 3). During the award period, Dr. Butler will build upon her background in bioethics and early experience in qualitative and epidemiologic research to acquire new expertise in the use of applied qualitative methods, design and conduct of cohort studies, and development and testing of communication tools. This career development plan will be supported by the exceptional research environment at the University of Washington, including the Kidney Research Institute and the Seattle-Denver VA Center of Innovation. Dr. Butler's primary mentor, Dr. Ann O'Hare, is an internationally recognized physician scientist whose research focuses on complex care processes for older adults with kidney disease. Dr. Butler's co-mentors have complementary expertise in transplant epidemiology (Dr. Peter Reese) and communication tool development and testing (Dr. Margaret “Gretchen” Schwarze). The work proposed here will lay the foundation for a future trial to test the communication tool developed during the award period and, more broadly, will identify multiple avenues to improve upon the transplant evaluation process at both the individual- and systems-levels. Collectively, this work will position Dr. Butler to become a successful independent physician scientist whose research focuses on fostering a more person-centered and equitable approach to the kidney transplant evaluation process.

项目摘要 /摘要 该K23申请的目标是支持考虑肾脏的老年人共同决策 移植评估并促进凯瑟琳·巴特勒（Catherine Butler）博士的身体科学家过渡到独立性 他们的研究重点是使移植评估过程以人为本和公平。 对于越来越多的肾衰竭老年人，肾脏移植可能是一个有价值的治疗选择， 但是，由于他们的预期寿命有限和合并症的高燃烧，大多数人都不会收到肾脏。 此外，移植评估本身可能是耗时，磨损和风险的，尤其是对于较老的 特别容易受到侵略性筛查和治疗的并发症的成年人。我们的 初步工作表明，患者通常对移植的期望几乎没有任何了解 评估和塑造其参与的机会有限。共同决策的过程可以帮助 老年人在肾脏移植评估中涉及复杂的权衡和不确定性。 我们提出了一项综合研究议程，旨在加强围绕转诊的共同决策 老年人中的肾脏移植。首先，我们将进行基于面试的定性研究，以引起 与移植评估过程有关的老年人的经验和观点 以及他们的家人和临床医生（AIM 1）。其次，我们将描述持续时间和可能性 在移植过程中完成分散步骤 （目标2）。最后，在前两个目标的情况下，我们将适应和试点测试以支持的交流工具 围绕肾衰竭老年人移植的转介的共同决策（AIM 3）。 在颁奖期间，巴特勒博士将以她的生物伦理学和早期经验为基础 定性和流行病学研究，以获取使用应用定性方法的新专业知识， 队列研究的设计和行为，交流工具的开发和测试。这个职业 发展计划将得到华盛顿大学的杰出研究环境的支持 包括肾脏研究所和西雅图 - 丹佛VA创新中心。巴特勒博士的小学 导师安·奥黑尔（Ann O'Hare）博士是一位国际认可的物理科学家，其研究重点 老年人患有肾脏疾病的复杂护理过程。巴特勒博士的联合委员会有完整的 移植流行病学（Peter Reese博士）和通信工具开发和测试的专业知识（博士 玛格丽特“格蕾琴”施瓦兹）。这里提出的工作将为以后的审判奠定基础，以测试 在颁奖期间开发的沟通工具，更广泛地将确定多种途径 改进个人和系统级别的移植评估过程。总的来说，这 工作将使巴特勒博士成为一名成功的独立物理科学家，其研究重点 培养以人为本和公平的方法来进行肾脏移植评估过程。